This blogpost contains brief notes by me (Juline) from a clinical perspective on the paper cited below. The notes are made for my personal use, but posted here in case they are of interest or use to others.

The paper’s title includes “self-conscious emotions” which include shame, guilt, embarrassment, jealousy, pride and empathy. However the paper refers to only two of them: guilt and shame. Both have long been associated with suicide; and both arise often in the context of women’s experiences of child sexual abuse, which is investigated as a mediating factor in the conversion of guilt and shame into suicidal thoughts. High levels of shame are known to be a factor inhibiting recovery following childhood sexual trauma.

The researchers wanted to know whether “a history of childhood sexual trauma would be implicated in the relationship between self-conscious emotions [here meaning guilt and shame] and suicidal thoughts”.

It was already suspected that context does affect the degree to which guilt and shame contribute to suicidality. For example the following links are mentioned:

Context:

Link observed:

Active duty military outpatients

GUILT and SUICIDAL IDEATION are strongly linked

Patients with body dysmorphia

SHAME and SUICIDAL RISK are strongly linked

Patients with OCD

SHAME and SUICIDAL RISK are strongly linked

By way of example, the paper suggests the following causal mechanisms:

It was not found, contrary to the researchers’ expectations, that women with a history of child sexual abuse were more prone to distress than those who were not.

A direct positive association was found between guilt/shame and the frequency of suicidal thoughts.

A history of child sexual abuse did alter the relationship between guilt/shame and suicidal thoughts, roughly as follows:

Women with no history of childhood sexual abuse

Higher levels of GUILT were associated with suicidal thoughts, but lower levels of SHAME

Women with a history of childhood sexual abuse

Higher levels of SHAME were associated with suicidal thoughts, but lower levels of GUILT

Some of the headlines that can be extracted from the Discussion section are as follows:

It is important to understand the nuanced relationship between shame/guilt and suicidal ideation, in which trauma potentially plays a plays a significant part.

This has important clinical implications. The study suggests the need for carefully assessing each client’s experience of trauma and guilt/shame; and the aftermath of traumatic experiences should be taken into account to optimise the effectiveness of therapeutic interventions.

The paper goes on to reprise topics such as the links found in the existing literature between shame and child sexual abuse and indications for therapeutic approached for different instances. These are linked to, but not based on, the findings of the paper.

Comment

As noted in the paper, the exploration of suicidal ideation is, where appropriate, central to psychotherapy. A psychotherapist will routinely explore a client’s sense of guilt or shame where this is present; and will be aware that any childhood trauma, disclosed or not, may be a factor in both the origin of these and suicidal thoughts. Working with shame is already well embedded within the literature of working with clients who have experienced sexual abuse. It is not obvious (to me) how the headline findings would have a practical impact on how a psychotherapist might already work with clients. A possibility is that the ‘careful assessment’ recommended includes more systematic screening for such factors early in the relationship, though this might be inimical to the client-led ethos of many psychotherapists.